Class action over medical policy gets green light in court
The Legal Intelligencer
A proposed federal classaction lawsuit against Allstate over its policy mandating that claimants undergo medical exams by a doctor of the carrier's choosing before they can receive benefits has gotten the green light in a ruling that predicts how the Pennsylvania Supreme Court may handle the situation.
U.S. District Judge A. Richard Caputo of the Middle District of Pennsylvania ruled last month in Sayles v. Allstate Insurance that Allstate's policy provision conflicted with the state Motor Vehicle Financial Responsibility Law, and predicted that the state Supreme Court would find the provision unenforceable.
“Because it appears that Allstate's examination requirement permits the insurer to require its insureds to submit to an [independent medical exam] without first filing a petition demonstrating good cause, and because the examination requirement transfers control over the statutory safeguards from the province of an impartial court to discretion of an interested insurer, the court predicts that the Pennsylvania Supreme Court would find the examination requirement, as alleged, in conflict with Section 1796 and thus violative of Pennsylvania public policy,” Judge Caputo said.
Although the ruling green-lighted claims that the policy conflicts with the Motor Vehicle Financial Responsibility, Judge Caputo dismissed all other claims raised.
Charles Kannebecker of Weinstein Schneider Kannebecker & Lokuta, who represents plaintiff Samantha Sayles, said the ruling should provide “tremendous clarity” on the issue.
“Now independent judges will determine who the examining physician will be, so the insurance company can't use their hand-picked doctors,” Mr. Kannebecker said.
Marc Wolin of Saiber LLC, who represented Allstate, did not return a call for comment.
According to Judge Caputo, Ms. Sayles was injured in a car accident in December 2015. Allstate subsequently requested that she undergo an independent medical exam by a doctor that the carrier chose before she could receive any benefits. Allstate never petitioned the court to compel the physical exam.
Ms. Sayles challenged the policy, arguing it violated the state law, which, she argued, requires carriers to get a court order based on “good cause” before refusing to pay the benefits.
Ms. Sayles lodged a proposed class action against Allstate over the policy, seeking a declaratory judgment that the policy violated the Motor Vehicle Financial Responsibility Law and the Pennsylvania Unfair Trade Practices and Consumer Protection Law. She also alleged that the policy violated the state Bad Faith Act, was a breach of the duty of good faith and fair dealing, and that the company violated statutes against unjust enrichment andmisrepresentation.
Allstate said the law did not mandate a court order, but only suggests when a court may order a person to submit to an independent medical exam.